Free Forms & Learning Resources for Eating Disorder Treatment

You can expedite your appointment by completing these registration forms before you arrive. Print out our blank forms by clicking each form needed below and fill out prior to your next office visit. Please note, not all Initial History Forms will apply to every new patient. For questions about completing the forms, please call 314-737-4070. Upon your arrival to our office, please give your completed forms to the receptionist.

Download Forms:

• HIPPA Acknowledgement Form
• HIPPA Privacy Document
• Patient Info Form
• Initial Patient History Form
• Initial Child & Adolescent History Form
• Initial Parent History Form

The Clinical Impairment Assessment Questionnaire (CIA) is a self-report used to measure psychosocial impairment due to eating disorder features. The CIA is typically completed shortly after completing the Eating Disorder Examination Questionnaire (EDE-Q).

The Eating Disorders Examination (EDE-Q) is a self-report used to help diagnose eating disorders. It is a questionnaire that is followed up with an interview by a professional to help confirm its validity.

A Food Diary is a form of self-monitoring. If you have ever kept a food diary (written down and kept track of what you consumed), then you have self-monitored. Self-monitoring is just a fancy way of saying you are keeping a record of the foods and beverages you are eating. Self-monitoring is critical to changing any behavior, including achieving healthy weight management. It also has the added benefit of increasing mindfulness around food consumption.